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PubMed2000

Nutritional status of institutionalized and free-living elderly in Alexandria.

Because of an increase in the number of elderly and the problems of nutrition associated with them, it is of interest to study the nutritional status of elderly persons in Alexandria City. The purpose of this study was to assess the nutritional status of elderly population and to compare between the nutritional status of those institutionalized and those living free. The study was conducted on 240 elderly persons (120 institutionalized and 120 free living) selected randomly from institutions and from different sites. The basic data, weight, height, body mass index (BMI) of each were recorded. Dietary intake study was done by using 24 hours recall for 3 consecutive days and food frequency were used to obtain the best estimate of food intake. Energy and nutrient intakes were obtained and compared with the recommended dietary allowance (RDAs). The main findings of the study revealed that the mean age of the institutionalized elderly was greater than those living free. Percent of obesity among females was 71.7% among free living and 45% among institutionalized. Under-nutrition was present in 11.7% and 8.3% of institutionalized males and females respectively. Food habits showed that institutionalized subjects consume more amounts of many food items than free-living. Total daily energy intake was found to be below the recommendation for all subjects, with higher intake among institutionalized than free living. Nutrient intakes among institutionalized and free living elderly were inadequate except thiamin, riboflavin, vitamin C and iron. The nutrients least adequately supplied in the diets of elderly are vitamin A and calcium along with energy deficits. In conclusion both institutionalized and free living are at risk for developing nutrient deficiencies. Deficient energy, calcium and vitamin A are common problems among most subjects. The composition of the diet among free living subjects seem to be also poor in some micronutrients. We recommended a nutrition intervention program and nutrition education to improve nutritional status of elderly people.

Aged↗
PubMed2001

Predictors of institutionalization of cognitively-impaired elderly cared for by their relatives.

OBJECTIVES: The purpose of this study is to identify risk factors for nursing home placement of cognitively-impaired elderly, with special attention to the role of psychosocial factors such as the caregiver's preference for institutionalization and the quality of the dyadic relationship. METHODS: Partners, children and children-in-law caring for a relative suffering from dementia (n = 144) were interviewed at home. Sociodemographic variables, patient characteristics, characteristics of the caregiving situation, caregiver characteristics, the support with care and the quality of the caregiving relationship are included as predictors of the caregiver's preference for institutionalization and of the actual institutionalization six to nine months later. Data are analyzed using multiple (logistic) regression analyses. RESULTS: The hypothesis that a poor quality of the relationship, besides other determinants, will be predictive of institutionalization received partial support. No relationship is found between the premorbid relationship quality and institutionalization (preference and actual). However, a good current relationship between the caregiver and the patient reduced the risk of nursing home placement. Institutionalization rate was 16.5% and it was predicted by the caregiver's preference for institutionalization, the functional level of the patient, the quality of the current relationship and the performance of accommodation changes at home. CONCLUSION: Research and interventions directed at delaying or preventing institutionalization should pay more attention to the role of psychosocial aspects in the process of nursing home placement. Specifically the relationship quality in terms of criticism or warmth might be a critical factor in the continuation of home care.

Activities of Daily Living↗
PubMed2004

Oro-facial manifestations in paediatric HIV: a comparative study of institutionalized and hospital outpatients.

The aim of the study was to compare dental caries status and the number and type of oral mucosal lesions in HIV positive children from a hospital outpatient department and an institutionalized setting. Oral examinations were performed using presumptive diagnostic criteria. The Fisher's Exact and the Mann-Whitney tests were used for statistical comparison of the two study groups. A total of 169 children were examined of whom 42% were institutionalized and 58% hospital outpatients. One institutionalized child presented with Noma. Twenty-one percent of the institutionalized population presented with molluscum contagiosum, while none of the hospital outpatients presented with this condition. Significantly more intraoral mucosal lesions were observed in the hospital compared with the institutionalized group. The most frequently encountered oral lesion was candidiasis. Pseudomembranous candidiasis was the most common type. Twice as many intraoral ulcers were recorded in the institutionalized group. Thirty-nine percent of the hospitalized patients had multiple lesions compared with 28% in the institutionalized group. Almost three quarters of both populations were caries-free. The mean DMFT was considerably higher in the hospital population. For both the permanent and primary teeth, the decayed component (D/d) made up the major part of the DMFT/dmft, followed by the missing (M/m) component. No fillings were recorded in either the primary or permanent teeth for both groups. Oral lesions are common in HIV populations and were seen in both the hospital and institutionalized groups, at high prevalence levels (63 and 45%). HIV infected children should be considered high risk for caries because of the use of chronic medications, and to receive appropriate care in terms of both treatment and services.

Candidiasis, Oral↗
PubMed2000

Mortality and institutionalization following hip fracture.

OBJECTIVES: To identify determinants of mortality and institutionalization after hip fracture and to identify those older hip fracture patients at high risk of death or institutionalization after hip fracture. DESIGN: Population-based prospective inception cohort study of hip fracture patients; patients were assessed in the hospital and at 3 months following the hip fracture. SETTING: Edmonton area hip fracture patients admitted to one of two Edmonton, Alberta, Canada, acute care centers between July 10, 1996, and August 31, 1997. PARTICIPANTS: Patients were residents of the Edmonton area and over the age of 64. Those who had previously fractured the same hip within the past 5 years or had some pathological condition underlying the hip fracture were excluded. Of 610 eligible patients, 558 contributed some baseline information and were included in the mortality analysis; the institutionalization analysis was restricted to the 338 patients who lived in the community before fracture, survived the 3-month period postfracture, and had completed a 3-month follow-up interview. MEASUREMENTS: The baseline interview was done in the hospital to assess mental status, prefracture physical function, prefracture health perception, and prefracture social support. The 3-month follow-up interview was done by phone to assess physical function, health perception, and social support 3 months postfracture. Demographic and comorbidity information was collected from medical records. RESULTS: Low mental status in hospital was found to increase the chances of mortality and institutionalization, and male gender was found to increase mortality risk fourfold. Each additional 10 years of age increased the risk of institutionalization approximately 2.5 times. Patients with lower postfracture physical function had at least five times the risk of institutionalization compared to patients with high postfracture physical function. CONCLUSIONS: Cognitive impairment, older age, and gender were associated with increased risk of poor outcome following hip fracture. The socioeconomic variables--social support and health perception--did not contribute significant additional information in explaining mortality or institutionalization risk. While demographic factors cannot be modified, physical function 3 months postfracture may be amenable to intervention and may reduce the risk of institutionalization. Intervening to increase postfracture physical function may be particularly beneficial to older patients, or to those who are cognitively impaired.

Aged↗
PubMed2002

[Predictors of long-term institutionalization in patients with Alzheimer's disease: role of caregiver burden].

BACKGROUND AND PURPOSE: The decision of long-term institutionalization of patients with Alzheimer's disease (AD) is based on multiple patients' and caregivers' characteristics. It is very important to find out factors associated with institutionalization for the timely institutionalization, i.e. for the prevention of premature institutionalization. Among those factors, caregiver burden is reportedly one of the most important factors in Europe and North America. However, no studies have been carried out in Japan. In order to address this issue, we studied outcome of patients with AD. SUBJECTS AND METHODS: Subjects were 211 patients who fulfilled the criteria of the National Institute of Neurological Disease and Stroke/Alzheimer's Disease and Related Disorders Association for probable AD. Diagnosis of AD was made through extensive examinations including MRI and PET/SPECT of the brain. The patients included 149 women and 62 men; the mean age was 73.1 +/- 8.0 (SD) years. The Japanese version of Zarit Caregiver Burden Interview (ZBI), which is a validated tool for assessment of the burden of caregivers for dementia patients, was used to evaluate caregivers' burden through the interview of a principal caregiver by trained nurses. Cognitive, functional, and neuropsychiatric impairments were assessed with standardized instruments of the Mini-Mental State Examination (MMSE), Hyogo Activities of Daily Living Scale (HADLS), Neuropsychiatric Inventory (NPI), respectively. We annually sent a questionnaire to the caregivers to collect information on the patients' status. It included questions whether and when they died or were institutionalized and whether they had used formal social supports such as home care, day care, and respite care services. MAIN OUTCOME MEASURE: Time to death or institutionalization. RESULTS: One-hundred and fifty subjects were followed for at least one year and 51 of them met either end point. The Cox proportional hazard model demonstrated that the baseline caregiver burden was a significant predictor of the end point even after controlling possible confounders. Among these, the use of day care and home care services during the course were significant protective factors. The baseline cognitive and functional disturbances but not neuropsychiatric manifestations were significantly associated with the end point. CONCLUSIONS: The caregiver burden is a significant predictor for the death or institutionalization of the patients with AD. The caregiver education which decrease the caregiver burden and prompt the usage of the social care services are necessary to protect premature institutionalization.

Activities of Daily Living↗
PubMed2004

Influence of behavioral symptoms on rates of institutionalization for persons with Alzheimer's disease.

BACKGROUND: Recent studies indicate that behavioral symptoms may play a key role in decisions to institutionalize persons with Alzheimer's disease (AD), but the specific types of behavior that contribute to this increased risk have not been reliably identified. The relationship between behavioral symptoms and time to institutionalization was evaluated in a 4-year longitudinal study. METHOD: A total of 410 persons with the clinical diagnosis of AD completed annual clinical evaluations to assess cognitive impairment, functional limitations, delusions, hallucinations, depressive symptoms and physical aggression. Participation rates among survivors exceeded 90% for four follow-up evaluations with complete ascertainment of mortality and institutionalization. Time to institutionalization was evaluated using proportional hazards regression models in relation to time-varying clinical features. RESULTS: In multivariate models, adjusted for demographic and social variables, four clinical features emerged as the predominant predictors of institutionalization: cognitive impairment level, physical aggression, hallucinations and depressive symptoms. These associations were virtually unchanged in analyses controlling for mortality. CONCLUSIONS: Specific behavioral symptoms are important independent risk factors for institutionalization in persons with AD. Because behavioral symptoms are susceptible to therapy, efforts to modify or prevent these symptoms deserve careful consideration as a means to delay institutionalization for persons with this disease.

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PubMed1994

Sleep and ageing: the effect of institutionalization on subjective and objective characteristics of sleep.

To assess the impact of institutionalization on sleep/wake characteristics of elderly people, we compared subjective (study I: n = 160) and objective (study II: n = 30) sleep/wake measures of non-demented institutionalized subjects and age-matched non-institutionalized controls. We also evaluated the prevalence and causes of various sleep disturbances. The three living conditions, i.e. independently living (IL), service home (SH) and nursing home (NH) were respectively assumed to have minimal, moderate and maximal effects upon the timing, the amount and the quality of the sleep/wake behaviour of the persons involved. Study I showed that a higher level of institutionalization was significantly (p < 0.05) associated with phase-advanced sleep/wake patterns, increased amounts of time spent in bed during the 24-hour period and increased usage of prescribed sedative-hypnotic drugs. Poor sleep quality and disturbed sleep onset occurred significantly mostly in the SH group. No differences between groups were demonstrated with respect to the prevalence of disturbed sleep maintenance, parasomnias and difficulty with awakening and their possible causes, except for environmental noise which was exclusively reported by institutionalized subjects. No differences between groups for any of the objective measures were found (study II). Overall, our findings are in line with previous findings on this topic, although the observed high rate of poor sleep quality and sleep disturbances and their associated causes as observed in institutionalized subjects also occurs in an age-matched non-institutionalized population.

Activities of Daily Living↗
PubMed1994

Patterns and predictors of institutionalization in community-based dementia patients.

OBJECTIVE: To investigate patterns and predictors of institutionalization in a community-based sample of dementia patients. SETTING: The Mayo Clinic Alzheimer's Disease Patient Registry (ADPR), a community-based prospective registry. PATIENTS: Two hundred seventy-five participants, including 145 dementia patients and 130 controls on whom longitudinal follow-up data was available. The mean ages were 79.9 and 78.8 years, and the mean Mini-Mental State Examination (MMSE) scores at enrollment were 22.1 and 28.1 points for the demented cases and controls, respectively. MEASURES: Place of residence, marital status, number of direct support providers, global cognitive status, activities of daily living and instrumental activities of daily living were used in hazards modeling of institutionalization. RESULTS: The results from our community-based sample suggest a high rate of institutionalization for dementia patients. One-half of the sample of dementia patients were institutionalized within 2.5 years of enrollment in our patient registry. Identified assistance providers were absent in a significant proportion (36%) of our dementia sample. Marital status, global cognitive function, and functional status were significant terms in hazards models of institutionalization. Age, gender, number of direct caregivers, and dementia etiology were not associated with significant risk. Seventy-two percent of the dementia patients who died over the course of this study had been placed in nursing home care prior to death (with a mean length of stay of 2.8 years). CONCLUSIONS: Social (marital status) and disease-related variables (cognitive and functional status) are related to risk for institutionalization. These variables may be useful in estimating time to institutionalization in various clinical and research populations.

Aged↗
PubMed2006

Mobility limitations and cognitive deficits as predictors of institutionalization among community-dwelling older people.

PURPOSE: Mobility limitations and cognitive disorders have often been observed as risks for institutionalization. However, their combined effects on risk of institutionalization among initially community-dwelling older people have been less well reported. DESIGN: A prospective cohort study with 10-year surveillance on institutionalization. SUBJECTS: Study population (n = 476) consisted of 75- and 80-year-old people who were community-dwelling, had not been diagnosed with dementia, and participated in tests on walking speed and cognitive capacity at a research centre. MEASURES: Cognitive capacity was measured with three validated psychometric tests that were from the Wechsler Adult Intelligence Scale, Wechsler Memory Scale and Schaie-Thurstone Adult Mental Abilities Test. Mobility was measured with walking speed over a 10-m distance. Exclusive distribution based study groups were formed with cut-offs at the lowest third as follows: no limitation, solely mobility limitation, solely cognitive deficits, and combined mobility limitation and cognitive deficits. Cox proportional hazards model was used to determine the relative risks of institutionalization for the study groups. RESULTS: Eleven percent of the participants were institutionalized during the 10-year surveillance. The risk for institutionalization was 4.9 times greater (95% confidence interval: 2.1-11.2) for those who had co-existing mobility limitations and cognitive deficits than for those with no limitations. CONCLUSIONS: The findings show that the accumulation of limitations in physical and cognitive performance substantially decreases the possibility for a person remaining at home. This might be due to a decreased reserve capacity and ineffective compensatory strategies. Therefore, interventions targeted to improve even one limitation, or prevent accumulation of these risk factors, could significantly reduce the risk of institutionalization.

Aged↗
PubMed2004

A comparison of the electroencephalogram between institutionalized and community children in Romania.

Electroencephalographic (EEG) data were collected from a sample of institutionalized infants and young children in Bucharest, Romania, and were compared with EEG data from age-matched children from the local community who had never been institutionalized and who were living with their families in the Bucharest area. Compared with the never-institutionalized group, the institutionalized group showed a pattern of increased low-frequency (theta) power in posterior scalp regions and decreased high-frequency (alpha and beta) power, particularly at frontal and temporal electrode sites. This finding is consistent with EEG studies of children facing environmental adversity and children with learning disorders. The institutionalized group also showed less marked hemispheric EEG asymmetries than the never-institutionalized group, particularly in the temporal region. The results are discussed in the context of two models: that the pattern of EEG in the institutionalized children reflects a maturational lag in nervous system development, or that it reflects tonic cortical hypoactivation.

Alpha Rhythm↗
PubMed2005

Institutionalization after stroke.

BACKGROUND AND PURPOSE: There are widespread regional variations in the institutionalization rate after stroke. This study sought to identify the factors that predict institutionalization after a primary diagnosis of stroke and determine whether institutionalization rate could be used to assess the quality of hospital care. METHODS: A retrospective case note audit of 2778 consecutive admissions with stroke, between 1 September and 31 October 2000 from a randomly selected sample of 79 hospitals in England, Wales and Northern Ireland. Data were collected on demographics, case-mix, clinical outcome, organization of discharge, and place of residence at discharge and at three and six months. The figures from this audit were validated using data from the 1998 National Sentinel Audit of Stroke. RESULTS: Overall 14% of patients previously living at home were discharged to nursing or residential homes. Using logistic regression, Barthel Index score at discharge accounted for 40% of variation. Two-thirds of patients with a discharge Barthel score of < 5 were institutionalized. Age alone explained 14% and when taken together with discharge Barthel and length of stay it accounted for 54% of variation. On admission 22% of the variation in institutionalization rate could be accounted for by total Glasgow Coma Score (15, < 15), age and ability to walk unaided. Regional variations in institutionalization rates are evident and may in part be explained by differences in ease of access to the institutions. CONCLUSIONS: Discharge disability and older age were the dominant factors determining admission to nursing and residential homes. It is not possible to predict sufficiently reliably for an individual patient the likelihood of institutionalization at admission or at 72 h after admission, to justify early resource allocation decisions.

Age Distribution↗
PubMed2001

Bright light treatment decreases depression in institutionalized older adults: a placebo-controlled crossover study.

BACKGROUND: An important parallel exists between patients with seasonal affective disorder and institutionalized older adults. Many older patients, as a result of global physical decline and immobility, are confined to their rooms, experiencing little natural sunlight. Thus, institutionalized older adults are at risk for chronic light deprivation. Testing the hypothesis that chronic light deprivation might be responsible, at least in part, for some depression among institutionalized older adults, the aim of this study was to investigate the efficacy of morning bright light treatment on depression among older adults residing in a long-term care facility. METHODS: In a placebo controlled, crossover design, participants (N = 10, six women and four men; M age = 83.8) received each of the following: (i) 1 week (5 days) of 10,000 lux (therapeutic dose); (ii) 1 week (5 days) of 300 lux (placebo); or 1 week of no treatment (control). Each week of light treatment was 5 consecutive days, 30 minutes daily, with a wash-out period consisting of 1 week between conditions. RESULTS: Geriatric Depression Scale (GDS) scores at baseline during all treatment conditions were positively correlated (r = .81, p < .01) with months of institutionalization, where participants with higher GDS scores experienced more time institutionalized. Scores on the GDS remained unchanged during the placebo and control conditions, but depression scores decreased significantly during the 10,000 lux treatment (pretest GDS M = 15 vs posttest GDS M = 11, p < .01). After the 10,000 lux treatment, 50% of the participants no longer scored in the depressed range. Improvement during the 10,000 lux condition was positively correlated (r = .62, p < .05) to baseline GDS scores, where participants with higher GDS scores experienced greater improvement following the 10,000 lux treatment. CONCLUSIONS: The results of the present study suggest that bright light treatment may be effective among institutionalized older adults, providing nonpharmacological intervention in the treatment of depression. Furthermore, the length of institutionalization may play an important role in determining the efficacy of bright light treatment for older adults in the nursing-home setting.

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PubMed1979

Hepatitis-B surface antigen and antibody: prevalence and persistence in institutionalized and noninstitutionalized persons.

A total of 426 persons were studied in an attempt to more clearly define the high prevalence of hepatitis-B surface antigen (HBsAg) seen among institutionalized persons. HBsAg was found in 63.4 percent of the children and young adults with Down's syndrome (DS) at the Central Wisconsin Center (CWC) and in 45.5 percent of those at the Northern Wisconsin Center (NWC). Significantly more subjects with DS had hepatitis-B antigenemia than age- and sex-matched non-DS institutionalized subjects. Antibody (anti-HBs) to HBsAg was found in 19.5 percent of the DS subjects at CWC and in 38.6 percent of those at NWC. The prevalence of anti-HBs was similar among DS and non-DS institutionalized subjects. None of the noninstitutionalized subjects had HBsAg in their serums and their anti-HBs prevalence was low (2.1 percent). HBsAg was found to persist for at least 10 years in both DS and non-DS institutionalized subjects. However, persistence occurred more frequently among DS subjects. Anti-HBs persisted at least 10 years among non-DS subjects, but DS subjects tended to lose antibody sooner. The study findings indicated that the high prevalence of HBsAg seen in institutionalized DS subjects at CWC and NWC were not related to the age of the subject at admission nor to the duration of institutionalization.

Adolescent↗
PubMed2002

Predictors of institutionalization in patients with dementia in Korea.

BACKGROUND: Many studies have sought to determine the predictors of institutionalization of patients with dementia. Such studies, performed in developed western societies, have come to various conclusions which may not be supported in an East Asian culture such as that found in Korea. OBJECTIVES: This study aimed to determine the factors that predict institutionalization of patients in Korea diagnosed with dementia. METHODS: Seventy-nine cases (37 institutionalized, 42 community-dwelling) in the Kwangju area were evaluated for patient characteristics, severity of dementia symptoms, caregiver characteristics, burden and distress. Logistic regression was performed to determine predictors of actual institutionalization. RESULTS: Six predictors of institutionalization were identified. Of these, three were patient-related factors: higher score on the Clinical Dementia Rating, higher score on the Brief Psychiatric Rating Scale, and shorter duration of dementia. The other three were caregiver-related factors: younger age, higher education (formal schooling), and higher cost of home care. CONCLUSIONS: As seen in previous western studies, institutionalization of dementia sufferers was influenced by both patient and caregiver factors. But, the specific predictors and their relative influences might be explained best by the particular social, cultural and economic situation in Korea. This study was the first of its kind in Korea and, as such, could serve as a reference for future intra-cultural and cross-cultural comparisons.

Aged↗
PubMed2002

Cognitive scores, even within the normal range, predict death and institutionalization.

BACKGROUND: Dementia is a predictor of death and institutionalization. It is less clear if variations in cognition within the normal range predict adverse outcomes. OBJECTIVE: To determine if variation at the high end of cognitive test scores predicts mortality or institutionalization, independent of the effect of potential confounders. DESIGN: Secondary analysis of the Canadian Study of Health and Aging, a population-based longitudinal study with an initial data collection in 1991 and follow-up five years later. SETTING: Community-dwelling seniors living in Canada. PARTICIPANTS: 9008 consenting seniors were sampled from representative population registries in Canada. MEASURES: Age, gender, marital status, the Mini-Mental State Examination, self-rated health, and activities of daily living. OUTCOMES: Death or institutionalization over the five years of follow-up. RESULTS: Mini-Mental State Examination scores predicted mortality and institutionalization. The unadjusted odds ratio of mortality was 0.85 (95% confidence interval 0.84, 0.86) per point on the Mini-Mental State Examination, and the adjusted odds ratio was 0.95 (95% confidence interval 0.93, 0.97). The unadjusted odds ratio for institutionalization was 0.83 (95% confidence interval 0.82, 0.85), and the adjusted odds ratio was 0.91 (95% confidence interval 0.90, 0.94). This effect was present even in analyses restricted to those within the normal range of Time 1 Mini-Mental State Examination scores. CONCLUSIONS: Low normal cognitive test scores predict adverse outcomes. Clinicians should consider close clinical follow-up of those with low normal cognitive test scores. Further research is needed to target seniors for follow-up and possible intervention to decrease mortality and institutionalization risk.

Aged↗
PubMed1981

Pantothenic acid nutritional status in the elderly--institutionalized and noninstitutionalized.

Pantothenic acid nutritional status was evaluated in 37 men (32 noninstitutionalized and five institutionalized) and 54 women (33 noninstitutionalized and 21 institutionalized) 65 yr of age or older. A fasting blood sample, a 24-h urine specimen and a food consumption record for 1 wk were obtained from each subject. Hematological, anthropometric, and dietary parameters indicated these 91 subjects were similar to elderly populations evaluated in other studies. Pantothenic acid was analyzed by both radioimmunoassay and microbiological assay. By combining methods it was possible to differentiate various forms and derivatives of pantothenic acid. Free pantothenic acid, but not the phosphoderivatives, was observed in urine. Microbiological and radioimmunoassay estimations of pantothenic acid showed good correlation (r = 0.91). Pantothenic acid excretion in the institutionalized subjects (7.5 +/- 1.3 (x +/- SEM) mg/g creatinine) was comparable to the excretion levels in the noninstitutionalized subjects (5.9 +/- 0.6 mg/g creatinine). Those consuming pantothenic acid supplements had significantly higher excretion levels. Blood pantothenic acid values between the groups, noninstitutionalized (537 +/- 27.4 ng/ml) and institutionalized (615 +/- 47.3 ng/ml), were comparable. The average dietary intake of pantothenic acid for the elderly population studied was 5.9 +/- 0.1 mg/day with the institutionalized and noninstitutionalized subjects having a similar intake of 2.9 mg/1000 kcal. Institutionalized elderly males and females were consuming 2237 and 1962 kcal, respectively, while their noninstitutionalized counterparts were consuming 2201 and 1887 kcal.

Aged↗
PubMed2003

Predictors of institutionalization in an older population during a 13-year period: the effect of urge incontinence.

BACKGROUND: Longitudinal data on predictors of institutionalization in random older populations are limited. The aim here was to identify predictors of institutionalization in an unselected older population during a period of 13 years with a special focus on the prognostic value of urge incontinence. METHODS: A population-based prospective survey was conducted involving 366 men and 409 women aged 60 years and older. Age-adjusted and multivariate Cox proportional hazards models were used to examine the predictive association of urge incontinence, living arrangements, neurological, cardiovascular, musculoskeletal, and other chronic diseases, activities of daily living (ADL) disability, and depressive symptoms with institutionalization separately in men and women. RESULTS: Adjusted for age, ADL disability and other chronic diseases predicted institutionalization in both men and women. Urge incontinence and depressive symptoms in men and living alone and cardiovascular diseases in women were also significant predictors. In multivariate analyses where all potential predictors were included simultaneously, age (RR [relative risk] 1.15; 95% CI [confidence interval] 1.10-1.19), urge incontinence (RR 3.07; 95% CI 1.24-7.59), and depressive symptoms (RR 1.22; 95% CI 1.00-1.48) remained significant predictors of institutionalization in men. In women, age (RR 1.15; 95% CI 1.12-1.19) and living alone (RR 2.02; 95% CI 1.27-3.21) were independent predictors. CONCLUSIONS: In addition to age, urge incontinence and depressive symptoms in men and living alone in women are significant prognostic indicators of institutionalization. The greater prognostic value of urge incontinence in men compared with women emphasizes the importance of interventions aimed at promoting continence and coping with the problem both at the individual and caregiver levels especially among older men.

Activities of Daily Living↗
PubMed2003

Competing risk of household expansion or institutionalization in late life.

OBJECTIVES: The purpose of this study was to evaluate predictors of change in household size and institutionalization in late life. METHODS: The Duke Established Populations for Epidemiologic Studies of the Elderly cohort (n = 3730) was assessed annually (1986-1996). Independent variables included home ownership, income, cognitive and functional ability, chronic illness, mood, household size, social support, and stressful life events. Competing risk of household expansion or institutionalization was modeled using (a) hazard of either event and (b) odds of household expansion or institutionalization among elders who experienced an event. RESULTS: Hazard of either event was associated with younger age, Black race, lower income, cognitive problems and stability, functional abilities and deterioration, low chronic illness burden, being unmarried, having more living children, and recent life events. Among those who reported either event, odds of institutionalization (vs. household expansion) were associated with older age, White race, cognitive and functional problems, high chronic illness burden, being married, having fewer living children, smaller household size, social isolation, and exits of nonspouse coresidents. DISCUSSION: Modeling separate effects of whether there was a household expansion or institutionalization, and if so, which type of event occurred, and taking into account acute and evolving states, enabled more precise understanding of the complex mechanisms involved in determining continued community residence or institutionalization.

Activities of Daily Living↗